For more than 25 years of my life, like many other people with long term mental health problems, I preferred to see the same GP. We came to know each other quite well. I appreciated his advice and wisdom and trusted his opinion. Because he knew how I was when I was completely well and able to function normally (I have recurrent depression) he was able to recognise when I most definitely wasn’t.
On the occasions I saw other doctors in the practice they would ask me to summarise my lifetime of problems in a couple of sentences (or that was how it felt to me) and they were unable to see through my cloak of competence. Just because a person is smiling and ‘well-presented’ it doesn’t mean that they are not feeling suicidal- all of their energy is just being expended on holding things together. When you know a health professional, you are more likely to disclose important information and so have a care plan that is right for you. As a patient, it feels as though they are the keeper of your story.
In recent years it has become increasingly difficult to develop a relationship with a single GP. Many factors have contributed to this, but among those who have lost out the most are people with longer term mental health problems for whom the building of a trusting relationship is a really important part of care.
I can remember seeing a young man with a diagnosis of schizophrenia, who really needed to have the management of his diabetes reviewed but hadn’t built up a relationship with anyone in the practice. He couldn’t get out of bed early enough in the morning to succeed in the daily battle for an appointment, and his mobile was often out of credit.
Because I did a regular session in the practice as a psychiatrist, I was able to talk directly to the receptionists in the back office and get him booked in. But there was limited capacity to arrange another appointment with the same doctor for him. He felt detached from the practice and didn’t believe that anyone really cared about that.
Many people with mental health problems also have chronic physical conditions, and vice versa. The outcomes and quality of life for both benefit from building a longer-term relationship with a doctor and/or practice nurse. Recent research led by Professor Sir Denis Pereira Gray, who has championed continuity of care throughout his career, has demonstrated that it does indeed save lives. When he says:
‘doctors tend to overestimate their effectiveness when consulting with patients they do not know, and underestimate their effectiveness when consulting with patients they know’
Most of us will know exactly what he means – even if we are reluctant to admit it.
There are things that still can be done, even in the current environment with its emphasis on people getting fast access, to improve continuity of care for those people for whom it is particularly important. As Dr Jonathan Tomlinson writes in his accompaniment to the recent Nuffield Report ‘How to improve continuity in General practice’
‘Continuity for all of us is about trust and safety and knowing one another as people as well as by our idiosyncratic physiology’
Since my original GP retired, I have been ‘trying out’ the new ones in the practice. I am getting to know a couple of them, and they me, and that feels reassuring safe. There are other people out there who can still be the keepers of my story.
This is the fourth in our blog series to coincide with the release of Relias’ new mental health training courses for primary care. In part 5 of our blog series, author Linda Gask will discuss training for primary care mental health, and how to improve it. Subscribe above to ensure you don’t miss future posts.
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